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Objective: This study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands-free speech in laryngectomized patients. Methods: Twenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study-specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands-free speech, use and duration of hands-free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability. Results: The moldable adhesive enabled ASV fixation adequate for hands-free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands-free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands-free speech at baseline. The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8–144 h) and improved comfort, fit, and ease of speech. Conclusion: The moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands-free speech more regularly. Level of Evidence: 4 Laryngoscope, 2023.

Predicting definitive outcomes of post-thyroidectomy vocal fold paralysis (VFP) is challenging. We aimed to identify reliable predictors based on intraoperative neuromonitoring (IONM) and flexible fiberoptic laryngostroboscopy (FFL) findings.Among 1172 thyroid operations performed from April to December 2021, all patients who exhibited vocal fold paralysis (VFP) at post-operative laryngoscopy were included. IONM data, including type of loss of signal (LOS), were collected. Patients underwent FFL, with arytenoid motility assessment, at 15, 45 and 120 days post-operatively. Patients were divided into two groups: those who recovered vocal fold motility (VFM) by the 120th post-operative day (recovery group) and those who did not (non-recovery group).Fifty-nine VFP cases (5.0% of total patients) met the inclusion criteria. Eight patients were lost at follow-up and were excluded. Overall, 9 patients were included in the non-recovery group (0.8% of total patients) and 42 in the recovery group. Among various predictive factors, only arytenoid fixation (AF) at the 15th post-operative day and Type I LOS were significant predictors for no VFM recovery (p = 0.007, RR = 9.739, CI:1.3-72.3 and p = 0.001, RR = 9.25, CI:2.2-39.3 for AF and Type I injury, respectively). The combination of type of LOS and arytenoid motility at the 15th post-op day yielded satisfactory predictive values for the progression of transient VFP to permanent.Arytenoid motility at the 15th post-op day and type II LOS are associated with recovery of VFM. Type of LOS and FFL could be included in the follow-up protocols of patients with VFP to reliably predict clinical outcomes.

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease—2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score > 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score > 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the “time of meals” (mean score 65) following by the “sleep” (mean score 66) and “eating desire” (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.

Total Laryngectomy seriously affects on patients Quality of Life and on their psychological well-being. The aim of this study was to verify the effects of pre-operative Speech-Language Pathology counselling on laryngectomized patients. Pilot randomized controlled trial. Twenty-seven patients undergoing total laryngectomy and primary tracheoesophageal puncture were randomized as follows: 14/27 subjects were collocated in the Experimental group who received preoperative Speech-Language Pathology counselling and 13/27 in the Control group group that did not receive it. Two interviews and four questionnaires (Psychological Distress Inventory, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Italian-Self-Evaluation of Communication Experiences after Laryngeal Cancer) were administered immediately after surgery (T0), 1- (T1) and 3-months (T2) after hospital discharge in order to asses levels of distress, post-traumatic stress and anxious-depressive symptoms, acquisition and acceptance of the new voice. Student’s t test and chi square test showed that the two groups of patients were equivalent. Experimental group was more satisfied with the information and obtained statistically better (p

Purpose The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. Methods A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. Results In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p p p p Conclusions The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.

To evaluate the effects of new devices-heat and moisture exchangers (HMEs) and adhesives-on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy.Prospective crossover study.Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology-Head and Neck Surgery.Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life-5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire).Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D.Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.

The aim of this observational cohort study with a control group is to compare consonant perception skills in quiet and in noise in children with typical language and learning development and in children with dyslexia, with and without Speech Sound Disorder (SSD). Three groups were included: A control group of twenty children with normal reading abilities and typical language development, twelve children with dyslexia and typical language development and thirteen children with dyslexia and SSD. All subjects received a consonant recognition test in three different listening conditions (quiet, + 10 and 0 Signal-to-Noise Ratio). In all test conditions, children with dyslexia and SSD had significantly lower consonant recognition scores than the control group and the children with dyslexia and typical language development (p .0001). The poorer performances observed in children with dyslexia and SSD may be explained by impaired phonological processing underlying both conditions.

Objectives: We aim to analyze long-term voice outcomes and Quality of Life (QoL) in patients undergoing Open Partial Horizontal Laryngectomy Type II (OPHL Type II) and to compare them to those obtained by patients undergoing Total Laryngectomy (TL) with voice prosthesis (VP). Design: Cross-sectional cohort study Setting: patients undergoing surgery for advanced laryngeal cancer, assessed during the usual follow-up consultations at the Phoniatric Unit (February 2020-December 2020). Participants: Forty-five patients were enrolled and divided into two groups: OPHL Group and TL Group. Main outcomes measures: Maximum phonation time, INFV0 scale, I-SECEL, UWQoL-V4 and MDADI questionnaires were used to assess the long-term outcomes. Results: Voices of patients undergoing OPHL Type II were worse than those of laryngectomized patients with VP. Nevertheless, scores in voice and dysphagia-related QoL were comparable and scores in the Social domain of QoL were better in OPHL group. Conclusions. OPHL Type II allows an acceptable voice recovery and a satisfactory QoL.

To investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT15 patients with Parkinson's disease were assessed before LSVTA significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvFIn addition to the subjective and perceptual beneficial effect of LSVTValutazione multidimensionale della voce dopo riabilitazione vocale sec. Lee Silverman nei pazienti affetti da malattia di Parkinson.Valutare l’efficacia del LSVT® nel migliorare gli aspetti prosodici dei pazienti con malattia di Parkinson.Sono stati valutati 15 pazienti subito dopo il LSVT® e nei follow-up a una settimana, a 3 e a 6 mesi dal termine del trattamento attraverso la somministrazione dei seguenti strumenti: Voice Handicap Index -10 (VHI-10), scala GRBAS, item 18 dell’Unified Parkinson’s Disease Rating Scale III (UPDRS III), Tempo Massimo Fonatorio (TMF/s/), Voice Range Profile (VRP) e l’Intonation Stimulability Protocol del Motor Speech Profile (MSP).Dopo la terapia i parametri acustici Imax e rF0 hanno mostrato un incremento significativo che si è mantenuto nel follow-up a 6 mesi (p0,001), mentre per le variabili rSTD (p = 0,004), rVAm (p = 0,02) e rvF0 (p = 0-01) si è evidenziato un miglioramento significativo nel follow-up a 3 mesi che tuttavia non si è mantenuto nel successivo controllo a 6 mesi. Il punteggio dell’item 18 dell’UPDRS III ha mostrato un incremento significativo soltanto a una settimana dal termine del trattamento (p = 0,03). Infine si è evidenziato un miglioramento statisticamente significativo dei parametri G (Grado) e A (Astenia) della scala GRBAS così come del valore medio del VHI-10 sia subito dopo il LSVT® che nei successivi follow-up a 3 e a 6 mesi (p0,05).I risultati hanno evidenziato, oltre ad un miglioramento soggettivo e percettivo della sintomatologia, un incremento dell’intensità e della frequenza fondamentale. Il miglioramento dei parametri acustici relativi alla prosodia è stato temporaneo e non si è mantenuto nel tempo.

Finestra di un anno sulla gestione di pazienti con protesi fonatoria. È un carico clinico sovrastimato?La gestione delle complicanze tardive rappresenta il motivo principale della riluttanza nell’uso della riabilitazione con protesi fonatoria dopo laringectomia totale. Lo scopo del presente lavoro è descrivere un anno di gestione di un’ampia coorte di pazienti, al fine di chiarire quanto impegnativo sia il management in termini di carico lavorativo per i clinici dedicati. Nel periodo compreso tra giugno 2017 e giugno 2018, ogni accesso effettuato, presso la Clinica di Otorinolaringoiatria del nostro Istituto, da 70 pazienti laringectomizzati riabilitati con protesi fonatoria per problematiche legate al dispositivo protesico, è stato registrato su uno specifico database. L’analisi dei dati ha fornito informazioni sull’incidenza, la gestione e gli outcomes relativi a tutti gli eventi avversi riscontrati durante il periodo preso in esame. Al fine di valutare le differenze tra pazienti irradiati e non irradiati e pazienti sottoposti a posizionamento simultaneo e sequenziale/ritardato è stato, inoltre, utilizzato il test T di Student. Il leakage intravalvolare è stata la causa di accesso più frequente (51,86%). Il numero medio di accessi per paziente per anno è stato pari a 3,47. La logopedista ha gestito autonomamente il 18,1% degli accessi. Di conseguenza, il numero medio di accessi per paziente per anno che hanno necessitato di visita medica è stato pari a 2,84. La durata media del dispositivo protesico è stata pari a 4,85 mesi. La radioterapia o la tecnica di posizionamento utilizzata (simultanea o sequenziale/ritardata) non ha influenzato il numero di accessi per anno né la durata della protesi fonatoria. L’analisi retrospettiva dei risultati ha evidenziato le problematiche più frequenti e le misure più efficaci per affrontarle, permettendo la creazione di un algoritmo sistematico che agevoli e standardizzi il management a lungo termine di questi pazienti.Management of late complications represents the main reason for reluctance in using voice prosthesis rehabilitation. The aim of this paper is to report our experience by describing the one-year management of a large cohort of patients in order to clarify how demanding management is in terms of burden on clinicians. Between June 2017 and June 2018, each access made at the Otolaryngology Clinic of our Institute for issues related to prosthesis by 70 laryngectomised patients rehabilitated by voice prosthesis was registered in a specific database. A review of the data provided information on the incidence, management and outcomes of adverse events encountered during the selected time frame. In addition, a T test was used to evaluate the differences between irradiated and non-irradiated patients and between primary and secondary tracheo-oesophageal-puncture. Leakage through the prosthesis was the most common cause for access (51.86%). The median number of accesses per patient per year was 3.47. The speech therapist autonomously managed 18.1% of accesses. The median number of accesses per patient per year needing a physician was 2.84. The median lifetime of the prosthesis was 4.85 months. Radiotherapy or modality (primary or secondary) of the puncture did not influence the number of accesses per year or the prosthesis lifetime. This retrospective analysis of results highlighted the most frequent issues and the most effective measures to deal with them, which allowed us to define a systematic algorithm to standardise and ease long-term outpatient management.

Objective To describe a remote approach used with patients with voice prosthesis after laryngectomy during the COVID-19 pandemic and the resulting clinical outcomes in terms of voice prosthesis complications management, oncological monitoring, and psychophysical well-being. Study Design Prospective cohort study. Setting Otolaryngology Clinic of the University Polyclinic A. Gemelli, IRCCS Foundation. Subjects and Methods All patients with voice prosthesis who underwent laryngectomy followed by our institute were offered enrollment. Patients who agreed to participate were interviewed to inquire about the nature of the need and to plan a video call with the appropriate clinician. Before and 1 week after the clinician’s call, patients were tested with the Hospital Anxiety and Depression Scale. Degrees of satisfaction were investigated with a visual analog scale. A comparison between those who accepted and refused telematic support was carried out to identify factors that influence patient interest in teleservice. Results Video call service allowed us to reach 37 (50.68%) of 73 patients. In 23 (62.16%) of 37 cases, the video call was sufficient to manage the problem. In the remaining 14 cases (37.83%), an outpatient visit was necessary. Participants who refused telematic support had a significantly shorter time interval from the last ear, nose, and throat visit than patients who accepted (57.95 vs 96.14 days, P = .03). Video-called patients showed significantly decreased levels of anxiety and depression (mean Hospital Anxiety and Depression Scale total score pre– vs post–video call: 13.97 vs. 10.23, P < .0001) and reported high levels of satisfaction about the service. Conclusion Remote approach may be a viable support in the management of patients with voice prosthesis rehabilitation.

Taxi drivers represent a large group of workers employed in the service sector of transport. Many studies found an increased risk of a range of health disorders in relation to their irregular work shifts, inappropriate diet, drinking and smoking habits and their high exposure to gasoline- and diesel-engine exhaust fumes. The aim of the present study was to assess the sample of a larynx from taxi drivers, considering symptoms and endoscopic signs of laryngopharyngeal reflux (LPR) and precancerous lesions. Taxi drivers enrolled (n = 74) were questioned about their nicotine dependence using the Fagerstrom scale. The Reflux Symptom Index (RSI) was administered to screen LPR symptoms. Each subject underwent videolaryngoscopy with Reflux Finding Score (RFS) calculation. Data were compared with those obtained from the control group (n = 102). Taxi drivers’ group did not show a significantly greater dependence on cigarette smoking (p

A high percentage of patients suffered symptoms also after recovery from the Coronavirus Disease-2019 (COVID-19) infection. It is not well clear what are the specific long-term sequelae (complications and symptoms). During the acute phase the patients may develop a multi-organ system pathology including aerodigestive tract. As the pathophysiology of COVID-19 emerges, the aim of our study was to describe the prevalence of oropharyngeal dysphagia after COVID-19 disease. From March to July 2020 we enrolled patients recovered from SARS-CoV-2 infection who had been previously hospitalized for the disease. They were screened for dysphagia by mean of the Eating Assessment Tool-10 (EAT-10). The cases with EAT-10 score 3 were graded for the aspiration risk by applying the Gugging Swallowing Screen (GUSS) and were submitted to the Swal-QoL questionnaire. The cases with a GUSS score 19 were subjected to FEES. 8/117 (7%) patients had positive screening result. 4/8 (50%) revealed an abnormal health related quality of life in oropharyngeal dysphagia with a mean Swal-QoL score of 69.73. The most affected domain was the "time of meals" (mean score 65) following by the "sleep" (mean score 66) and "eating desire" (mean score 72). 1/8 cases showed increased risk for aspiration and did not showed endoscopic signs of oropharyngeal dysphagia. Our results showed that the prevalence of upper dysphagia after hospitalization for SARS-CoV-2 is not anecdotal and that probably this long-lasting sequela has a psychogenic etiology.

Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys-). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = -0.31; p < 0.05] and ASPECTS scores [r(48) = -0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.

Acquisition and acceptance of the alaryngeal voice, psychological state, and Quality of Life (QoL) of laryngectomized patients. Thirty-two patients who underwent total laryngectomy were included in the study; 17 of them were treated by a psychologist and a speech therapist (experimental group); 15 performed only speech therapy (control group). The experimental group showed a significant improvement in all parameters of the INFVo scale, in the score of the Environment subscale and in the total score of the I-SECEL (Self-Evaluation of Communication Experiences after Laryngeal Cancer); in the Depression, Obsession-Compulsion and Paranoia areas of the SCL-90-R (Symptom Check List-90-Revised); and in the Social area (REL) of the WHOQOL-B (World Health Organization Quality of Life Scale–Brief). An integrated rehabilitative approach to laryngectomized patients improves emotional state and psychosocial aspects and promotes acceptance and use of the new voice and recovery of a better quality of life.

Background To date very few studies have investigated the musical skills of children with specific language impairment (SLI). There is growing evidence that SLI affects areas other than language, and it is therefore reasonable to hypothesize that children with this disorder may have difficulties in perceiving musical stimuli appropriately. Aims To compare melody and song identification skills in a group of children with SLI and in a control group of children with typical language development (TD); and to study possible correlations between music identification skills and language abilities in the SLI group. Methods & Procedures This is a prospective case control study. Two groups of children were enrolled: one meeting DSM-IV-TR® diagnostic criteria for SLI and the other comprising an age-matched group of children with TD. All children received a melody and a song identification test, together with a test battery assessing receptive and productive language abilities. Outcomes & Results 30 children with SLI (mean age = 56 ± 9 months) and 23 with TD (mean age = 60 ± 10 months) were included. Melody and song identification scores among SLI children were significantly lower than those of TD children, and in both groups song identification scores were significantly higher than melody identification scores. Song identification skills bore a significant correlation to chronological age in both groups (TD: r = 0.529, p = 0.009; SLI: r = 0.506, p = 0.004). Whereas no other variables were found explaining the variability of melody or song identification scores in either group, the correlation between language comprehension and song identification in the SLI group approached significance (r = 0.166, p = 0.076). Conclusions & Implications The poorer music perception skills of SLI children as compared with TD ones suggests that SLI may also affect music perception. Therefore, training programmes that simultaneously stimulate via language and music may prove useful in the rehabilitation of children affected by SLI.

To evaluate the presence of symptoms of inattention and hyperactivity/impulsivity in a population of school age children affected by vocal fold nodules.Parents and teachers of 18 children with vocal fold nodules (10 males, eight females; aged between 6 and 12 years) and 20 matched controls without dysphonia and/or vocal fold diseases (11 males, nine females; aged between 6 and 12 years) completed Attention-Deficit/Hyperactivity Disorder (ADHD) rating scale for parents (SDAG [Scala per i Disturbi di Attenzione/Iperattività per Genitori]) and teachers (SDAI [Scala per i Disturbi di Attenzione/Iperattività per Insegnanti) rating scales containing in two subscales items that specifically evaluate the symptoms of ADHD according to the DSM-IV. All children were subjected to videolaryngoscopy.The group with vocal fold nodules scored significantly higher than the controls; the difference between the two groups was statistically significant for both the subscales of both questionnaires (SDAG and SDAI) (P 0.05). Four children in the group with vocal fold nodules who scored higher than 14 in at least one subscale were referred for psychiatric evaluation. For two of the children, both male, a diagnosis of combined ADHD was formulated.ADHD is a possible risk factor for the development of vocal fold nodules in childhood. SDAG and SDAI rating scales may supplement the diagnostic assessment of children with vocal fold nodules.

To report the results of functional outcome, dose trend and relationship between onabotulinumtoxinA (onabotA) dosage and the severity of disease or time between therapy sessions in patients affected by adductor spasmodic dysphonia (ADSD).Thirty-two patients underwent 193 EMG-guided intracordal injections of a starting dose of 2 MU of onabotA. At enrollment, each subject was administered the VHI. The response was evaluated using a subjective rating scale (0-100% of normal phonation).The quality of voice improved significantly after 1 month and stabilized by 3 months. The percentage of normal voice improved 33.34 ± 11.5% (min 26 - max 68). The functional gain was significantly worse in patients presenting with ADSD associated with dystonias in other body regions (31% vs 45% - p 0.05). The mean dose employed was 3.64 MU (min 1 - max 6) with a trend of increasing dosages up to the 5th treatment after which the doses stabilized over time. The pre-treatment VHI showed a weakly positive correlation with the cumulative dose at the 5th and 10th injections. Benefit duration and the mean between treatment interval were 103 and 136 days respectively. The correlation between dose and inter-injection time is weakly negative (r = -0.22, p 0.05), however, this is influenced predominantly by the first-to-second injection. After this initial treatment effect, the correlation becomes weakly positive (r = 0.12).Our data confirm the efficacy of onabotA to improve the quality of voice in cases of ADSD. The trial period for optimal dosage lasted up to a mean of five injections. The dosage of onabotA impacted the length of response and was influenced by the severity of ADSD. Finally the efficacy of onabotA did not change significantly after repeated administrations.

The aim of this study was to assess if a correlation exists between language learning skills and musical aptitude through the analysis of scholarly outcomes concerning the study of foreign languages and music. We enrolled 502 students from a secondary Italian school (10-14 years old), attending both traditional courses (2 hours/week of music classes scheduled) and special courses (six hours). For statistical analysis, we considered grades in English, French and Music. Our results showed a significant correlation between grades in the two foreign languages and in music, both in the traditional courses and in special courses, and better results in French than for special courses. These results are discussed and interpreted through the literature about neuroanatomical and physiological mechanisms of foreign language learning and music perception.Correlazione fra attitudine musicale e apprendimento delle lingue straniere: studio epidemiologico su studenti italiani della scuola media secondaria di primo grado.Scopo di questo studio è stato lo studio della relazione fra l’apprendimento delle lingue e le abilità musicali attraverso l’analisi dei risultati scolastici ottenuti da studenti della scuola secondaria nelle materie linguistiche e nello studio della musica. Sono stati inclusi nello studio 502 alunni (età 10-14 anni) di una scuola media secondaria di primo grado, divisi in classi tradizionali (2 ore settimanali di insegnamento della disciplina musicale) e classi “speciali musicali” (6 ore settimanali di insegnamento musicale). Sono stati considerati per l’analisi statistica i voti riportati nelle tre discipline: Inglese, Francese ed Educazione Musicale. I nostri risultati mostrano una correlazione statisticamente significativa fra i voti riportati nelle due lingue straniere e nella disciplina musicale sia nelle classi tradizionali che nelle classi speciali. Inoltre, nel confronto fra classi speciali “musicali” e classi tradizionali l’analisi statistica ha evidenziato una differenza statisticamente significativa per la lingua francese. I risultati vengono discussi ed interpretati sulla base della letteratura riguardante i meccanismi neuroanatomici e fisiologici che sottostanno all’apprendimento delle lingue straniere e della percezione musicale.

Summary Objective To investigate the relationships between objective measures and the results of subjective assessment of voice quality and speech intelligibility in patients submitted to total laryngectomy and tracheoesophageal (TE) puncture. Study Design Retrospective. Materials Twenty patients implanted with voice prosthesis were studied. After surgery, the entire sample performed speech rehabilitation. The assessment protocol included maximum phonation time (MPT), number of syllables per deep breath, acoustic analysis of the sustained vowel / a / and of a bisyllabic word, perceptual evaluation (pleasantness and intelligibility%), and self-assessment. Results The correlation between pleasantness and intelligibility% was statistically significant. Both the latter were significantly correlated with the acoustic signal type, the number of formant peaks, and the F 2 −F 1 difference. The intelligibility% and number of formant peaks were significantly correlated with the MPT and number of syllables per deep breath. Moreover, significant correlations were found between the number of formant peaks and both intelligibility% and pleasantness. The higher the number of syllables per deep breath and the longer the MPT, significantly higher was the number of formant peaks and the intelligibility%. The study failed to show significant correlation between patient's self-assessment of voice quality and both pleasantness and communication effectiveness. Conclusion The multidimensional assessment seems to be a reliable tool to evaluate the TE functional outcome. Particularly, the results showed that both pleasantness and intelligibility of TE speech are correlated to the availability of expired air and the function of the vocal tract.

Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy. Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size ≤30 mm, thyroid volume ≤30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score = VIS) and swallowing (swallowing impairment score = SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT. Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F 0, F low, F high, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT. The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery.

Background: Both the immediate beneficial physiological changes in a laboratory setting and the long-term clinical outcomes of heat and moisture exchanger (HME) use are well described. So far, there has not been any research published that provides detailed insight in the pattern of changes in both respiratory function and patients’ experiences with HMEs in the first weeks of use. Methods: A multicenter time-series study design with a 2-week double baseline period. All patients used the XtraHME for 12 weeks afterward. Data were collected 2 weeks, 6 weeks, and 12 weeks after the start of HME use. Results: Data of 30 patients were analyzed. Pulmonary symptoms decreased significantly during the 12 weeks of HME use. After 2 weeks, a significant decrease in daily coughs and daily forced expectorations was seen. The general quality of life showed a significant increase throughout the study. More general physical complaints also significantly decreased with HME use. Patient satisfaction with the HME was high. Conclusions: This study shows that there is a significant influence of the XtraHME on pulmonary status that can already be observed after 2 weeks of using the XtraHME and continues to improve further after 6 weeks of XtraHME use.

The primary functional issues following conservative therapy for advanced laryngeal cancer concern swallowing. Here, we evaluated the recovery of swallowing after supracricoid partial laryngectomy (SCL) in patients with primary or recurrent laryngeal cancer. We evaluated the swallowing recovery in 27 SCL patients through oropharyngoesophageal scintigraphy, and we evaluated their quality of life using EORTC questionnaires. Four patients underwent total laryngectomy during follow-up. Patients who retained their larynges were able to feed without nutritional support and without tracheostoma. The only significantly different parameter between the primary and salvage cases was the time elapsed to the removal of nasogastric/PEG tubes, which was longer in salvage cases. SCL has been demonstrated as a valuable option for primary and recurrent laryngeal cancer patients. The present data demonstrate good functional results, particularly in terms of swallowing after previous treatments and in primary settings. The combination of oropharyngoesophageal scintigraphy and questionnaires appears to be an adequate, standardizable approach to assessing swallowing function after SCL.

Objectives The short-term and long-term beneficial effects of HME use by laryngectomees are well described in literature. In this study, we document how laryngectomised patients, who previously did not use an HME, get accustomed to the use of HME and attachments. Participants Thirty patients, who were at least 3 months post-laryngectomy and previously did not use an HME, were followed for 12 weeks and were asked to complete questionnaires about their experiences with the HME and attachments. Results Results show that when patients start using an HME, they report some difficulties with breathing resistance during the first 2 weeks of use. However, after 6 weeks, they have become accustomed to the breathing resistance and after 12 weeks over 96% reports that breathing was equal or less strenuous compared with breathing though an open stoma. Only a small proportion of patients experienced problems with increased coughing when starting HME use. Conclusions This study provides insight in the way laryngectomised patients are experiencing the use of HMEs in the first weeks. These outcomes can contribute to a better knowledge of HME use by healthcare providers and help them to manage patient expectations and improving support to patients in achieving compliant HME use.

Occlusion alterations can be associated to bad habits (such as thumb sucking, oral breathing, atypical swallowing and labial interposition) which can lead to functional anomalies.Three cases are reported with the good results of myofunctional and orthodontic therapy.When there are bad habits, orthodontics should be combined with a myofunctional therapy.

Bad habits result in altered functions which with time can cause anomalies of the orofacial morphology. To solve these problems, orthodontic treatment can be supported by myofunctional therapy in order to recover the normal functionality of the oral muscles. The aim of this study is to assess the need to treat patients with neuromuscular disorders, from both the occlusion and the muscles condition approach in order to obtain the balance needed for the stability of treatment.A sample of 23 patients with atypical swallowing was included in this study, some of them presented thumb sucking and oral breathing. After case history collection, in order to make a correct orthodontic and functional diagnosis, correction of anomalies was carried out since they could compromise the success of the therapy (maxillary contraction, oral breathing, and short lingual fraenum). Then a different therapeutic approach was applied on the basis of the specific dental features.Both from the diagnostic and therapeutic point of view, important results were achieved especially through muscle analysis with dynamometer and surface electromyography.Orthodontic therapy, in the presence of bad habits, is not enough to solve orthodontic issues, it must be combined with a myofunctional treatment. The success of the therapy is granted only when patients and their family comply with the treatment and all factors which can prevent success of the therapy are removed.

Voice and swallowing symptoms following thyroidectomy in the absence of any demonstration of laryngeal nerves injury are usually considered a functional outcome of uncomplicated operations, mainly related to scar formation and emotional reaction. They could be related to unapparent laryngeal nerve or cricothyroid (CT) muscle injuries detectable only by laryngeal electromyography (LEMG). We correlated such symptoms with LEMG patterns. A total of 33 consenting patients undergoing total thyroidectomy (TT) were enrolled. Video-strobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed preoperatively and 3 months postoperatively. Subjective evaluation of voice (Voice Impairment Score, or VIS) and swallowing (Swallowing Impairment Score, or SIS) were obtained preoperatively and 1 and 3 months postoperatively. At 1 month postoperatively LEMG was performed examining thyroarytenoid (TA) and CT muscles to evaluate the inferior laryngeal nerve (ILN) and the external branch of the superior laryngeal nerve (EBSLN), respectively. One patient experienced transient vocal cord palsy and was excluded. The remaining 32 patients completed the postoperative evaluation. No significant difference was found between preoperative and postoperative AVA and MPT parameters. Mean VIS was significantly worse than preoperatively 1 and 3 months after TT. No significant difference was found between preoperative and postoperative SIS. LEMG evaluation of TA muscle showed decreased voluntary activity and spontaneous fibrillation potentials in one patient. LEMG of the CT muscle did not reveal any sign of EBSLN injury. Patients frequently complain of subjective symptoms early after TT. LEMG demonstrated the absence of subclinical laryngeal nerve injury in all but one patient, confirming their functional nature.

The aim of this study is to report three cases that needed myofunctional and orthodontic treatment and the good results achieved after the therapy. Orthodontic treatment alone, in presence of bad habits, is not enough to solve the orthodontic issues, so it needs to be combined with myofunctional treatment.

Objective To compare the music perception skills of a group of Italian-speaking children with cochlear implants to those of a group of normal hearing children; to analyze possible correlations between implanted children's musical skills and their demographics, clinical characteristics, phonological perception, and speech recognition and production abilities. Methods 18 implanted children aged 5–12 years and a reference group of 23 normal-hearing subjects with typical language development were enrolled. Both groups received a melody identification test and a song (i.e. original version) identification test. The implanted children also received a test battery aimed at assessing speech recognition, speech production and phoneme discrimination. Results The implanted children scored significantly worse than the normal hearing subjects in both musical tests. In the cochlear implant group, phoneme discrimination abilities were significantly correlated with both melody and song identification skills, and length of device use was significantly correlated with song identification skills. Conclusions Experience with device use and phonological perception had a moderate-to-strong correlation to implanted children's music perception abilities. In the light of these findings, it is reasonable to assume that a rehabilitation program specifically aimed at improving phonological perception could help pediatric cochlear implant recipients better understand the basic elements of music; moreover, a training aimed at improving the comprehension of the spectral elements of music could enhance implanted children's phonological skills.

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

To compare oncological outcome and voice quality among a uniform and well-defined subset of patients with T1 glottic carcinoma. Patients, affected by laryngeal glottic carcinoma, treated by laser CO2 surgery or radiotherapy, have been analyzed. Overall survival and disease-free survival were calculated. In order to verify differences in functional outcomes and voice quality, all patients were interviewed during their last follow-up visit during 2009 using the VHI (Voice Handicap Index) questionnaire. The data were analyzed using the MedCalc software. A total of 143 patients were analyzed: 73 underwent surgery and 70 underwent radiotherapy. No statistically significant differences were found between the two groups in terms of overall survival and disease-free survival; dividing patients into stages T1a and T1b also made no difference. In order to evaluate the differences in outcomes for surgery and radiotherapy, patients were interviewed using the VHI questionnaire. Better scores for each category in the VHI were found for patients receiving radiotherapy compared to surgery (physical: p = 0.0023; functional: p < 0.0001; environmental: p < 0.001). The median VHI score for radiotherapy patients was 4, while for surgical patients it was 18 (p < 0.0001). This study confirms the well-known knowledge that results from radiotherapy and surgery in early glottic cancer treatment are equivalent. Furthermore, the role of patient preference in the treatment modality choice and the value of a multidisciplinary approach for a detailed and multi-oriented discussion with the patient are outlined.

Background Voice and swallowing symptoms are frequently reported early after thyroidectomy even in the absence of laryngeal nerves injury. We evaluated the short-term and long-term outcomes of these functional alterations. Methods Consenting patients undergoing total thyroidectomy (TT) were enrolled. Videolaryngostroboscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) were performed pre-operatively, 3 months postoperatively, and >1 year postoperatively. Subjective evaluation of voice (Voice Impairment Score = VIS) and swallowing (Swallowing Impairment Score = SIS) were obtained pre-operatively, as well as 1 week, 1 month, 3 months, and >1 year postoperatively. Results The long-term evaluation was completed in 110 patients. The percentage of patients with symptoms 1 week after operation was significantly higher than preoperatively, whereas it was significantly lower at long-term evaluation. VIS was significantly worse than pre-operatively, 1 week, 1 month, and 3 months after surgery, but it was similar to pre-operative >1 year after TT. SIS was significantly worse 1 week after thyroidectomy but not 1 month and 3 months after thyroidectomy, and it was significantly lower than the pre-operative >1 year after TT. Conclusion Vocal and swallowing symptoms are frequent after TT. In the absence of laryngeal nerve injury, after an initial impairment, late after operation, patients experienced subjective amelioration of their voice and swallowing performances, which may be related to the resolution of compressive symptoms.

Objective:To evaluate the functional results obtained after voice therapy in patients with unilateral vocal fold paralysis caused by different aetiologies.Design:Prospective analysis of the outcome of unilateral vocal fold paralysis cases treated at our speech and language rehabilitation service from November 2003 to January 2006. Thirty cases underwent behavioural treatment, between two and six weeks after unilateral vocal fold paralysis onset. A multi-dimensional assessment was carried out before, immediately after and six months after treatment.Results:After behavioural therapy, the prevalence of complete glottal closure increased significantly (p p vs 0.04). At both post-treatment assessments, voice range profile analysis showed a significant decrease of lowest voice frequency and a significant increase of the number of semitones (p p Conclusions:Early voice therapy may enable significant improvement in vocal function, allowing the patient to avoid surgery.

Background. We performed a prospective analysis on voice and swallowing alterations following total thyroidectomy (TT), in the absence of recurrent nerve injury. Methods. Patients aged 21 to 65 years undergoing TT, in the absence of laryngeal/pulmonary disease, previous neck surgery, or malignant diseases, were subjected to videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) tests preoperatively and 3 months postoperatively. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Results. Among the 127 selected patients, 39 completed the postoperative evaluation. No recurrent nerve injury was observed during the postoperative VSL in any of the patients. Preoperative and postoperative AVA and MPT scores did not differ significantly. The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT (13.7 and 9.6 vs 4.4, respectively; P .05) but not 3 months after TT (6.7). The mean SIS was higher than the preoperative SIS at 1 week, 1 month, and 3 months after TT (10.3, 6.0, and 2.8 vs 0.5, respectively; P .05). Conclusions. Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients. (Surgery 2006;140:1026-34.)

Background The most frequent postthyroidectomy complication is recurrent laryngeal nerve (RLN) damage with subsequent vocal cord palsy. Methods We have undertaken an intraoperative study aimed to determine the course, distribution, and RLN's anatomical relationships with adjacent structures. Only its identification and its careful exposure allow prevention of iatrogenic injuries. Results The RLN was always routinely exposed and identified in 1,543 thyroidectomies. All patients underwent laryngoscopic evaluation before surgery and at the time of discharge. A total of 2,626 RLN were observed. The number of nerves exposed to risk was 673 (25.6%). In the whole series, of 2626 nerves controlled, there were 11 (0.4%) permanent palsies. Conclusions Our study confirms that damage to the RLN or to one of its branches may be avoided only by identification and careful exposure of the nerve itself. An experienced surgeon with good knowledge of the anatomy of the RLN and its anatomical variations is required for uncomplicated treatment of thyroid disease.

Background. The aim of this study was to investigate the incidence of injury to the external branch of the superior laryngeal nerve (EBSLN) with 2 different surgical approaches. Methods. From 1998 to 2000, 289 consecutive patients undergoing thyroidectomy were randomly divided into 2 groups. In group A (137 patients [215 upper pole ligations]), the superior thyroid artery was ligated after identification of the EBSLN. In group B (152 patients [244 upper pole ligations]), the superior thyroid artery's branches were ligated separately close to the gland. In all patients, a phoniatric evaluation with videostrobolaryngoscopy and spectrographic examination was performed. Results. The 2 groups were well matched regarding age, sex, thyroid pathological findings, and type of operation. In group A, the EBSLN was not clearly identified in 11.6% of cases. Alterations of EBSLN function were absent in both groups of patients, either postoperatively or 1 and 6 months after operation. Group B showed statistically significant shorter operative time compared with that for group A. Conclusions. Even if the EBSLN often crosses the superior thyroid pedicle, especially in large goiters, this study demonstrated that accurate distal ligation of the branches of the superior thyroid artery is a safe technique to prevent EBSLN injury. (Surgery 2001;130:1055-9.)

The study of the anatomical variations of the external ear is important for the ear surgeon who assesses the middle ear in this way. Furthermore, the design of insert earmoulds for use with either hearing aids or portable radios requires a better knowledge of the shape of the external ear. We studied the external ear structures and the drumhead in 140 cadavers with no previous history of ear pathology. A silicone resin was used, employing a dental impression technique. These permanent impressions were analysed by means of an operating microscope. Different parameters were studied, to determine the average dimensions of the structures. The clinical significance of these results is discussed.

A case of T1N0M0carcinoma of the tongue in a male 23-year-old ‘regular’ marijuana smoker is described. Hemiglossectomy and complete bilateral neck dissection were carried out. No post-operative radiotherapy was given as the resection margins were histologically negative. The tumour recurred one year later in the left cervical region involving the mandible and surgery was again performed, but after three months, neck disease was still evident. The case described case implies the introduction of marijuana as a possible new risk factor in the development of oral cavity tumours. Resection of the primary lesion has to be as wide as possible even in T1cases, due to the aggressive biological behaviour of such tumours in young subjects.